Ultrasound Screenings After UTI in Children May Miss Abnormalities if Limited to Under-2: Study Suggests
Finland: A recent study published in Acta Paediatrica has brought new insights into the detection of urinary tract abnormalities in children following a urinary tract infection (UTI). Conducted by Dr. Mikael Hakkola and colleagues from the University of Oulu in Finland, the study questions the prevailing practice of limiting ultrasound (US) screening to children under two years of age after a UTI episode.
The cohort study assessed 2050 children aged 0–16 years who underwent US screening after experiencing a UTI between 2004 and 2015 at a pediatric university hospital in Finland. Importantly, children with known urinary tract pathologies were excluded to ensure the focus remained on new or previously undetected abnormalities.
The key findings include the following:
- 5.7% (116 out of 2050) of the children had abnormal findings on their urinary tract ultrasound.
- Among children diagnosed with pyelonephritis, 70% of the abnormalities were found in those younger than two years.
- Being under two years of age did not significantly increase the risk of abnormal ultrasound findings (odds ratio: 0.99).
- Male children were more likely to have urinary tract abnormalities.
- Children with recurrent urinary tract infections showed a higher risk of abnormalities.
- Infections caused by pathogens other than Escherichia coli were associated with a greater likelihood of abnormal ultrasound results.
Current clinical guidelines in many countries recommend conducting a urinary tract ultrasound only in children under the age of two following a UTI. However, the study highlights that this approach could result in missing nearly one-third of children with abnormalities, as 30% of the abnormal findings in pyelonephritis cases occurred in children older than two.
“Our findings suggest that the existing age cut-off in guidelines may not be sufficient to detect all cases of urinary tract abnormalities after UTI,” the researchers noted. They advocate for expanding ultrasound screening to include all children after their first episode of pyelonephritis, irrespective of age.
The authors call for a reassessment of current diagnostic protocols and recommend that future research adopt a prospective, longitudinal approach encompassing children of all ages diagnosed with UTI. This would offer a clearer understanding of the risk distribution and help optimize screening strategies to improve early detection of potential complications.
The authors concluded, "The study urges pediatricians and healthcare policymakers to reconsider current practices surrounding post-UTI imaging. Broadening the screening criteria could play a key role in early identification and management of urinary tract abnormalities, thereby improving outcomes for affected children."
Reference:
Hakkola, M., Tervo, I., Pieviläinen, O., Heiskanen, J., Honkila, M., Pokka, T., Paalanne, N., Venhola, M., Perhomaa, M., & Ruuska-Loewald, T. Abnormal Ultrasound Findings After a Urinary Tract Infection in Children. Acta Paediatrica. https://doi.org/10.1111/apa.70152
